I work with athletes at the college level (usually freshman just coming into our program). I notice our students have a lot of knee pain after the first semester. The training schedule is much more rigorous than they were used to in high school, so that might be why. I did some digging around and found that military cadets (also at the freshman level) seem to have fewer of these problems. What are they doing in their training that might make a difference (something we could do, too)?

Knee pain is a very common problem in athletes who run, jump, and/or participate in sports that require these movements. Many athletes develop a problem called patellofemoral pain syndrome (PFPS) as a result. This painful knee problem can be chronic and prevent full participation in sports activities because of the pain. Anything that requires knee flexion (squatting or bending) seems to be particularly problematic.

Most of the time, there are anatomical and postural alignment reasons for PFPS. Some are modifiable (can be changed), while others cannot. Factors that can’t be changed with taping, bracing, shoes, exercises, or concentrating on changing movement patterns are called nonmodifiable.

Military recruits have been the subject of several studies involving PFPS. These young men and women are usually in fairly good shape when they enter the program. They participate in the same physical conditioning and sports activities making it easier to compare those who develop PFPS with those who don’t. Additionally, they aren’t overweight, so that’s one factor that can be eliminated.

A recent study of over 1500 naval academy freshman reported fewer students with PFPS than is commonly reported in the literature studying other (nonmilitary) athletes. The researchers weren’t specifically looking for reasons why this was so. They suggested that some recruits might adopt a tough-it-out attitude and ignore the pain. Others might learn ways to change how they do activities that cause pain. These compensation strategies might reduce the pain or at least make it possible to withstand the pain. Going to the troop medical clinic or asking to see a doctor might be perceived by this group as unacceptable. So, in fact, they may have just as many problems as your freshman, they just don’t report it.

Even so, the authors of that study suggested a good place to maybe prevent knee problem is strengthening the quadriceps and hamstring muscles and teaching proper techniques for activities that are painful. Active young adults such as military recruits and athletes can be assessed before engaging in physical activities that could potentially lead to the development of patellofemoral pain syndrome. Anyone with modifiable risk factors can be trained to change the way they move and perform dynamic tasks such as knee flexion and jump/landing. Changing the hip angle (less internal rotation) and knee angle (more knee flexion) might make a difference in these active groups of people.